Vascular: Carotid Artery Aneurysm

Extracranial Carotid Artery Aneurysm (ECAA)

Basics

  • Aneurysmal Dilation of the Carotid Artery Outside the Skull
  • Most Common Sites: Bifurcation & Proximal ICA

Causes

  • Atherosclerotic Degeneration – Most Common Cause
  • Trauma
  • Dissection
  • Infection
  • Radiation
  • Fibromuscular Dysplasia
  • Complication After Carotid Endarterectomy

Presentation

  • Painless Pulsatile Mass – Most Common
  • Pain & Erythema if Infected
  • Amaurosis Fugax
  • TIA/CVA
  • Horner’s Syndrome – Compression of Sympathetic Chain
  • Hoarseness – Vagus Compression
  • Rupture (Rare)

Types

  • Type I: Isolated to the ICA
  • Type II: Complete ICA, Involving the Bifurcation
  • Type III: Bifurcation
  • Type IV: ICA & CCA
  • Type V: Isolated to the CCA

Diagnosis

  • Dx: US or CTA/MRA

Carotid Artery Aneurysm on CTA 1

Cervical Swelling from Carotid Aneurysm 1

Treatment

  • Small & Asymptomatic: Observation
  • Surgical/Endovascular Interventions:
    • General Indications:
      • Large (> 2 cm) or Enlarging
      • Symptomatic
      • Mycotic Aneurysm
      • Thrombosis within Aneurysm
    • Possible Interventions:
      • Surgical Excision with End-to-End Anastomosis or Interposition Graft
      • Endovascular Stents or Coiling
        • Often Preferred if in Distal ICA without Unstable Thrombosis

References

  1. Panda A, Mahajan M. Unusual cause of asymptomatic neck swelling. Ann Med Health Sci Res. 2014 Mar;4(Suppl 1):S67. (License: CC BY-NC-SA-3.0)